APPLICATION FORM

(To be filled in by the office)

Recent
Passport
Application No. : _________________________ Photograph
No. & Date of receipt : _________________________

Post applied for : ____________________________________

Department : ____________________________________

Specialization : ____________________________________

Signature of Receiving Officer : ____________________________________

DD No. Date Amount (₹) Name of issuing Bank

(To be filled in by candidates)

* Before filling of the application forms candidates should properly go through the
instructions/terms and conditions

1. a) Advertisement No. : _____________________________________________

b) Post applied for : _____________________________________________

c) Department : _____________________________________________

d) Specialization : _____________________________________________

2. Full name of the candidate : ________________________________________________

(in block letters)

3. Date of Birth (in Christian era) : ________________________________________________

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 4. Father’s Name : ________________________________________________

Mother’s Name ________________________________________________

5. Nationality : ________________________________________________

6. Religion ________________________________________________

7. Present Postal Address : ________________________________________________

(in block letters)
________________________________________________
________________________________________________
________________________________________________

8. Permanent Address : ________________________________________________

(in block letters)
________________________________________________
________________________________________________
________________________________________________

9. Tel. No: Landline : (O)_____________________________________________

(with STD code)
Mobile No. (R)_____________________________________________

10. Email ID : ________________________________________________

11. Whether belongs to : ________________________________________________

SC/ST/OBC/PH

12. Marital Status : ________________________________________________

13. Languages known : ________________________________________________

(Read, Write & Speak)
________________________________________________
________________________________________________

14. Education qualifications (Starting with the highest degree)

Degree awarded/ University/Board Year of passing Percentage of Subject/
Examination marks obtained/ Specialization
passed CGPA
Post Graduation

Graduation

Senior Secondary
(Plus Two)
High School

Others

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 15. List of all your previous employments in order (Most recent first)

Sl. Name of Employer Designation From To Salary Brief Reasons for

No. Details description of leaving
duties

16.
(i) Present Scale of Pay _______________________ (ii) Basic Pay ________________________

(iii) Date of Next Increment ____________________ (iv) Gross Pay _______________________

(v) Basic Pay acceptable _______________________

17. Awards/Recognitions won, if any : ________________________________________

18. Period required for joining the post, if selected : ________________________________________

19. Brief details of Co-curricular and extra-curricular activities:

Sl. Activity From To Remarks
No.

20. Any other relevant information you may like to furnish: (Attach separate sheets)

21. Outreach activity if any: _________________________________________________________________

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22. References: (Responsible persons, not related to the applicant but closely acquainted with academic
and professional work)
Sl. Name and Designation Address
No.
1) Phone :
E-mail :
Fax :
2) Phone :
E-mail :
Fax :
3) Phone :
E-mail :
Fax :

23. List of Enclosures

1) 6)
2) 7)
3) 8)
4) 9)
5) 10)
11) 12)

Declaration:
I certify that the aforementioned information is correct and complete to the best of my
knowledge and belief.

(Signature of Candidate)

Place______________________
Date_______________________

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 FORWARDED

(To be filled in by the present employer)

Place: Signature of the Forwarding Authority:

Date: Designation:

Office Seal:
__________________________________________________________________________________

N.B.: Every application must be accompanied by Attested Xerox copies of documents in

support of claims made by the candidate in respect of his date of birth, academic qualifications,
practical training, experience, caste, etc. A list of copies of certificates etc., attached to this
application is to be given.
_______________________________________________________________________________

INSTRUCTIONS

i) The Application Form should be enclosed with Demand Draft of Rs. 500/- for General/OBC category
in the form of Demand Draft in favour of Director, NIT Manipur payable at State Bank of India,
Secretariat Branch, Imphal.
ii) SC/ST (supporting certificate must be enclosed in the form)/Persons with Disabilities (PWDs) upon
submission of relevant Disability Certificate issued by the competent authority and Women candidates
are fully exempted from payment of the prescribed fees.

iii) Copies of all certificates/testimonials should be attached and originals will have to be shown at the time
of Interview.

iv) Persons in employment should send their applications through proper channel. However, they may
send a copy in advance, but it must be on the prescribed form & accompanied by the required Demand
Draft, copies of certificates/testimonials etc.

v) Applications received after the due date or found incomplete may not be considered.

vi) The Form should be enclosed with prescribed application fee

vii) Applicants who have earlier applied to the cancelled advertisements mentioned in notification no.
NITM.1/(2a-Estt)/MP/REG/2017(Pt)/315 dated 23rd July, 2018 need not submit the
processing/application fee. However, they are required to furnish the details of the draft submitted.
CHECKLIST:
a) Caste Certificate (if reservation/fee concession claimed). For OBC candidates, OBC Status
and Non-Creamy Layer Status in the prescribed format duly issued on or after 15 th July, 2018)
b) Certificates and marks sheet/grade card of all degrees, 12 th and 10th
c) Experience certificate
d) Certificates of all other additional qualifications claimed, if any
e) Age Proof (HSLC/HSC or equivalent certificate issued by competent authority )

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